tbuckley/cabot-search huggingface dataset:
Abstract 12066: Older Age and Higher Number of Comorbidities Are Associated With Therapeutic Inertia for Blood Pressure Control
Authors: Grant T Hiura, Talar W Markossian, Holly J Kramer, Beatrice D Probst, Mohammad Samie Tootooni
Journal: Circulation (2022)

Introduction: Therapeutic inertia, defined as failure to initiate or escalate dose of blood pressure (BP) lowering medications when BP goals are not achieved, remains a major barrier to improving BP control rates. This study examines factors associated with therapeutic inertia for hypertensive ambulatory patients receiving care in university-affiliated primary care clinics. Methods: This retrospective cohort study included 8,451 hypertensive adults age &gt; 65 years with &gt; 1 primary care follow-up visit within one year between January 1, 2017 and January 31, 2021. Sociodemographic and clinical data, including comorbidities of diabetes, obesity, and cardiovascular disease, were extracted from the electronic health record. Generalized linear mixed models with a binomial distribution were used to calculate adjusted odds of therapeutic inertia during a clinic visit when BP was elevated by age group (65-74, ≥ 75 years) and number of comorbidities (0, 1, 2, 3-4, &gt; 5), after adjustment for covariates. An interaction term of age group * number of comorbidities in the adjusted model was statistically significant (P&lt;0.001), so marginal effects were used to calculate adjusted probabilities of therapeutic inertia at a clinic visit by age group and by number of comorbidities. Results: Mean age was 75 ± 8 years old, 42% were male, and race was 72% White, 17% Black, and 11% other. Across 28,585 clinic visits when BP was elevated, mean SBP and DBP were 152 ± 13 and 78 ± 11 mmHg, respectively, and therapeutic inertia occurred in 75% (21,325) of visits. Figure 1 shows that mean adjusted probability of therapeutic inertia among adults with 0 to &gt; 5 comorbidities ranged from 64 ± 15 % to 81 ± 12% with age 65-74 years, respectively, and 70 ± 15% to 82 ± 11% with age ≥ 75 years. Conclusions: Therapeutic inertia is common among older hypertensive adults with multiple comorbidities, and interventions are needed to address lack of medication escalation when BP remains uncontrolled.
Abstract 11682: Spiked Helmet Sign - Poor Prognostic Sign or Artifact?
Authors: Yousif Al-Saiegh, Jenna Spears, Steven Liskov, Gan-Xin Yan
Journal: Circulation (2022)

81 year old female with lung cancer suffered a PEA cardiac arrest while receiving chemotherapy. She received 20 minutes of CPR. Upon arrival to the ICU, she was afebrile, BP 85/55 mmHg on mechanical ventilation. Labs were unrevealing. ECG showed sinus tachycardia with normal intervals and ST segments. Pulmonary embolism and aortic pathology were ruled out. A TTE showed normal biventricular size and function without significant valvular abnormalities. An anaphylactic reaction to the chemotherapy was hypothesized as etiology of her arrest. After initiation of norepinephrine, dynamic oscillatory changes were noted on telemetry and confirmed on 12 lead ECG with a sharp R wave, convex ST changes and QT prolongation, resembling the spiked helmet sign (Fig. 1). Prompt work up showed no abnormal labs and a hyperdynamic left ventricle on TTE. The patient recovered well and was discharged to a nursing facility. The spiked helmet sign was first described in 2011 and defined as an upward shift of the isoelectric baseline followed by a sharp R wave and a convex ST segment elevation; commonly seen in inferior leads. It was exclusively observed in critically ill patients and associated with a high mortality. The mechanism has not been established yet. Proposed mechanisms include possible activation of the diaphragm by the inferior wall of the left ventricle or increased intrathoracic pressure during ventilation. We propose referred aortic pulsation as the mechanism. Specifically, when the left leg (LL) lead - as seen in this patient and frequently done in clinical practice- is placed on the abdomen. This explains the synchronicity of the upsloping with the QRS complex, and why it affects the inferior leads (Fig. 1c). We were able to reproduce the pattern by manually tapping on the LL lead in the same patient (Fig. 1b). The spiked helmet sign is associated with a poor prognosis despite poorly understood mechanism. Further studies are required to prove a cardiac mechanism as opposed to an artifact.
Abstract 12416: Factors Associated With Somatic Symptoms Perception in Patients With Heart Failure
Authors: KANAKO HAYASHI, Akiko Okada, Shinya Ito, Miyuki Tsuchihashi-Makaya
Journal: Circulation (2022)

Introduction: Since symptoms as perceived by patients are subjective experiences, it is important to understand from the patient's perspective the symptoms that they perceive as distressing or unpleasant. Investigating the reality of such symptoms as perceived by heart failure (HF) patients and related factors will help to construct effective nursing interventions for symptom relief in HF patients. Aim: To clarify the factors related to the symptoms using the Heart Failure Somatic Perception Scale (HFSPS) of HF as perceived by HF patients. Methods: The study population consisted of outpatients with HF who were assessed for symptoms as perceived by HF patients by the HFSPS, as well as self-care behaviors and depression by a questionnaire. Multiple regression analyses were applied to the factors associated with the perception of HF symptoms for each HFSPS subscale. Results: A total of 315 patients (mean age 73 years, 72% male) were included. The mean score of HFSPS total was 11.7±12.3, and the scores of each subscale of the HFSPS were dyspnea (3.3±4.8), chest discomfort (1.3±1.7), early subtle (5.3±4.9) and edema (1.8±2.6). HFSPS total score was associated with severity of HF (standard partial regression coefficient (β) = 0.16, 95% confidence interval (CI) 0.62~5.51, p=0.014), depression (β = 0.28, CI=0.46~1.04, p&lt;0.01), self-care maintenance (β=-0.27, CI=-0.31~-0.12, p&lt;0.01), and symptom perception (β=0.20, CI=0.05~0.20, p&lt;0.01). Dyspnea indicated severity of HF (β=0.18, CI=0.35~2.38, p&lt;0.01), depression (β=0.28, CI=0.18~0.40, p&lt;0.01), self-care maintenance (β=-0.15, CI=0.08~0.01, p&lt;0.01), chest discomfort indicated self-care maintenance (β=-0.24, CI=-0.04~-0.01, p&lt;0.01), symptom perception (β=0.27, CI=0.01~0.03, p&lt;0.01), depression (β=0.34, CI=0.25~0.48, p&lt;0.01) for early subtle, self-care maintenance (β=- 0.27, CI=-0.13~-0.05, p&lt;0.01), symptom perception (β=0.18, CI=0.01~0.07, p&lt;0.01), and depression (β=0.12, CI=0.01~0.14, p=0.03) were shown for edema. Conclusion: Assessing symptoms as perceived by the HF patient is expected to help the health care provider understand the patient's perceived symptoms and provide comprehensive treatment and care that is appropriate to the patient's characteristics.
Abstract 12632: Relationships Between Circadian Ambulatory Systolic Blood Pressure Variability With Subclinical Atherosclerosis in Healthy Middle-Aged Individuals
Authors: YIU-HEI TSE, Matthew HSU, Kong Kam Tim Siriphong Pijarnvanit, Carman Nga-Man CHEUNG, Yick Hin Chow, Brian C. W. KOT, Hung-Fat Tse, Kui Kai Lau
Journal: Circulation (2022)

Background: Short-term fluctuations in blood pressure (BP) as measured by 24-hr ambulatory BP monitoring (ABPM) is associated with subclinical atherosclerosis in the general population. However, whether short-term blood pressure variability (BPV) in the day versus night-time has differential effects on the development of subclinical atherosclerosis is uncertain. Methods and Results: We investigated the relationship between mean 24-hr BP and BPV parameters with common carotid artery intima-media thickness (CIMT) in 305 middle-aged Chinese (mean age 54±7years, 45% male) free from hypertension, hyperlipidaemia, diabetes or cardiovascular diseases. Subclinical atherosclerosis with elevated CIMT was defined as &gt;75th percentile of CIMT of the overall study cohort. Linear regression models adjusted for age, sex, body mass index and smoking status revealed significant associations between office, day- and night-time mean SBP, day-time SBP standard deviation (SD) and coefficient of variation (CV) with elevated CIMT (all p&lt;0.05). As shown in the Table , logistic regression analysis demonstrated that only ABPM day-time mean SBP (odds ratio [OR]:2.54, 95% confidence interval [95%CI]:1.29-5.00), night-time mean SBP (OR:3.23, 95%CI:1.67-6.22), night-time mean DBP (OR:2.27, 95%CI:1.16-4.42), day-time SBP CV (OR:0.47, 95%CI:0.26-0.86) and night-time SBP SD (OR1.94, 1.05-3.58) predicted the occurrence of subclinical atherosclerosis (all p&lt;0.05). Conclusions: In healthy middle-age individuals without known hypertension, mean day and night-time SBP as measured using ABPM provided the strongest positive predictive value for elevated CIMT. Interestingly, increase day-time SBP CV versus night-time SBP SD have opposite effects on CIMT, suggesting circadian changes in SBP might have distinct contributions to the development of subclinical atherosclerosis.
Abstract 12676: Psychological Stress Stimulates Vascular Inflammatory Responses and Destabilizes Atherosclerotic Plaques as Assessed by High-Speed, High-Resolution Intravital Imaging
Authors: Joon Woo W Song, Minseok Jang, Dong Oh Kang, Ryeong Hyun Kim, Hyun Jung Kim, Jin Hyuk Kim, Eun Jin Park, Ye Hee Park, Bo-Hyung Lee, Chi Kyung Kim, Kyeongsoon Park, Hongki Yoo, Jin Kim
Journal: Circulation (2022)

Backgrounds: Psychological stress increases leukocyte accumulation within atherosclerotic lesions and exacerbates plaque vulnerability. However, the stress-induced real-time behavior of immune cells in the atheroma has been poorly defined in vivo . Here, we aim to investigate whether stress stimulates the inflammatory leukocyte dynamics in the atherosclerotic plaques and destabilizes the lesions using customized in vivo cell tracking strategies. Methods and Results: We developed a system and motion reconstruction algorithm that can probe and compensate for respiratory and pulsatile movements. Individual leukocytes near the atherosclerotic plaques were imaged in real-time by adapting a custom-built high-speed intravital microscopy system with multiple fluorescence channels. Stress was achieved by immobilization procedures and/or stereotaxic application of stress stimulus onto the brain amygdala. The high spatial and temporal resolution of our real-time cell tracking system allowed clear identification of rhodamine 6G-positive leukocytes in vivo . In the common femoral artery bifurcation of apolipoprotein E knockout mice, white blood cells firmly adhered to the inner layer of the vessel walls while some slowly flowed along the endothelium (Figure). We further demonstrate that the stress increased the rolling and adhesion of inflammatory leukocyte subsets near the atherosclerotic lesions, and enhanced the plaque macrophage activity as assessed by in vivo imaging. Confocal laser scanning microscopy and immunostaining analyses corroborated the in vivo findings that the stress induced the destabilization of the atherosclerotic plaques. Conclusion: Our data show that stress stimulated the dynamics of inflammatory leukocyte subsets in atherosclerotic environments and increased the plaque vulnerability as assessed by the customized high-resolution motion-compensated in vivo imaging strategy.
Abstract 11974: A Randomized, Controlled Trial of Resistance Training Added to Caloric Restriction Plus Aerobic Exercise Training in Obese Heart Failure With Preserved Ejection Fraction
Authors: Peter H Brubaker, Barbara Nicklas, Denise Houston, William G Hundley, Haiying Chen, Anthony Molina, Mary Lyles, Michael Nelson, Bharathi Upadhya, Russ Newland, Dalane W Kitzman
Journal: Circulation (2022)

Background: We previously showed that the combination of caloric restriction (CR) and aerobic exercise training (AT) produce robust improvements in exercise capacity and quality of life (QOL) in patients with obese Heart Failure with Preserved Ejection Fraction (HFpEF). However, ~ 35% of weight lost during CR+AT was from skeletal muscle (SM) mass, which may have adverse long-term consequences. Hypothesis: The addition of resistance training (RT) to CR+AT would reduce SM loss and further improve exercise capacity and QOL. Methods: Randomized, controlled, single blind trial of 20 weeks of RT+CR+AT vs. CR+AT in 88 patients with HFpEF and body mass index (BMI) ≥28 kg/m 2 . Measurements were: peak exercise O 2 consumption (VO 2 ); body composition by MRI and dual X-ray absorptiometry; leg muscle strength; leg muscle quality (leg strength ÷ leg SM area); Kansas City Cardiomyopathy Questionnaire (KCCQ) total score. Results: 77 participants completed the trial: age 68±5 years; 85% women; BMI 39.6±5.8 kg/m 2 . Both RT+CR+AT and CR+AT had substantial weight loss, mean (95% CI): -8.1 (-9.3, -6.8) vs. -9.2 (-10.5, -7.9) kg with no significant intergroup difference (p=0.21). Both RT+CR+AT and CR+AT had substantial loss of total body fat [-6.5 (-7.2, -5.8) vs. -7.4 (-8.1, -6.7) kg] and SM [-2.1 (-2.7,- 1.5) vs. -2.1 (-2.7, -1.4) kg], with no intergroup differences (p=0.20 and 0.23, respectively). Despite similar relative loss of SM (26% vs. 23% of total weight lost), RT+CR+AT vs. CR+AT alone produced significantly greater increases in leg muscle strength [4.9 (0.7, 9.0) vs. -1.1 (-5.5, 3.2) Nm, p=0.05] and leg muscle quality [0.07 (0.03, 0.11) vs. 0.02 (-0.02, 0.06) Nm/cm 2 , p=0.04]. Both RT+CR+AT and CR+AT produced large, significant improvements in peak VO 2 [108 (958, 157) vs. 80 (30, 130) ml/min; p=0.001 and 0.002, respectively], and in KCCQ score [17 (12, 22) vs. 23 (17, 28); p=0.001 for both], with no significant intergroup differences (p=0.21 and p=0.07, respectively). There were no study related serious adverse events. Conclusion: In older obese HFpEF patients, CR+AT produces large, significant improvements in exercise capacity and QOL. Addition of RT to CR+AT increased leg strength and leg muscle quality without attenuating SM loss or further increasing peak VO 2 or KCCQ score.
Abstract 12058: The Impact of Cardiovascular Health Intervention on Plasma Metabolomic Profiles
Authors: Nour Beydoun, Chang Liu, Shabatun Islam, Kimberly Rooney, Herman A Taylor, Dean Jones, Priscilla E Igho-Pemu, Arshed A Quyyumi, Charles D Searles
Journal: Circulation (2022)

Introduction: Previously, we used plasma metabolomics profiling to identify metabolites underlying cardiovascular health (CVH) in participants of the Morehouse-Emory Cardiovascular (MECA) Center for Health Equity Study. Herein, we explored whether a health intervention could alter plasma concentrations of metabolites associated with CVH in MECA participants with poor CVH. Methods: 71 Black adults without known cardiovascular disease and with poor CVH, defined as AHA Life’s Simple 7 (LS7) score &lt;8, were given a technology-enabled behavioral intervention platform (Health360x) for 6 months with or without access to a health coach. Metabolites were assessed pre- and post-intervention by untargeted high-resolution metabolomics profiling. Metabolome wide association study (MWAS) was conducted to identify differentially expressed metabolites and Mummichog was used to identify metabolic pathways that were differentially enriched after the intervention. Annotations were performed by matching to an in-house library of confirmed metabolites. Paired t-test and Wilcoxon signed-rank test were used to compare clinical metrics. Results: Mean age was 55 + 9.0 years, 69% female. Total LS7 scores improved from 6.2 ( + 1.49) to 6.5 ( + 1.74) with the intervention. While total and subcomponent LS7 scores and clinical metrics (BMI, blood pressure, glucose and cholesterol levels) trended toward improvement, the changes were not statistically significant. MWAS identified 18 metabolites that were significantly changed after intervention, including glutamine and glutamate. Pathway analysis demonstrated 30 metabolic pathways that were significantly changed with intervention, including glutamate, aspartate, asparagine, arginine and proline metabolism. Conclusions: Six-months of lifestyle intervention altered activity of 30 metabolic pathways without significant alterations in the clinical metrics. These metabolites and pathways appear to be indicators of a healthier lifestyle in the Black population, potentially supporting their use as markers of CVH and possible therapeutic targets.
Abstract 11455: Outcomes of Latent Rheumatic Heart Disease: External Validation of a Simplified Score in Patients With And Without Secondary Prophylaxis
Authors: Bruno R Nascimento, Maria D Nunes, Jose Luiz Padilha da Silva, Andrew Steer, Daniel Engelman, Emmy Okello, Jafesi Pulle, Joselyn Rwebembera, Liesl Zuhlke, Mariana Mirabel, miriam nakitto, Rachel Sarnacki, Craig A Sable, Andrea Z Beaton
Journal: Circulation (2022)

Background: Secondary antibiotic prophylaxis reduces progression in children with latent rheumatic heart disease (RHD). However, nearly half of children show improvement with or without prophylaxis. Improved risk stratification could refine prophylaxis recommendations following positive screening echo. We aimed to validate a previously developed echo risk score to predict mid-term RHD outcomes among children with latent RHD. Methods: Our population included children who completed the GOAL Trial, a randomized controlled trial of secondary antibiotic prophylaxis among children with latent RHD in Uganda. These children underwent echo at enrollment and study completion, with rigorous blinded adjudication by a 4-member panel to establish diagnosis. We applied a point-based risk score developed from prior Brazilian and Ugandan cohorts, consisting of 5 variables (mitral valve (MV) anterior leaflet thickening (3 points), MV excessive leaflet tip motion (3), MV regurgitation jet length ≥2 cm (6), aortic valve focal thickening (4) and any aortic regurgitation (5)) to predict unfavorable outcome, defined as progression of diagnostic category (borderline to definite, definite mild valvular disease to definite moderate/severe disease) or remaining with definite RHD. Results: At total 801 patients (626 borderline and 175 definite RHD, mean age 12.5±2.9 years) were included, with median follow-up of 24 months. RHD progression was observed in 3 patients in the Penicillin group, vs. 33 in the control group, and overall, 386 patients regressed and 377 remained stable. The echo score was strongly associated with unfavorable outcome (OR: 1.25, 95% CI 1.15 - 1.36, p&lt;0.001). Unfavorable outcome rates in low (≤6 points), intermediate (7 - 9) and high-risk (≥10) children at follow-up were 12.2%, 31.1%, and 42.2%, (p&lt;0.001) respectively, with area under the ROC curve of 0.64 (95% CI 0.59 - 0.69). Among children without prophylaxis, the score had a similarly good performance: OR: 1.24 (95% CI 1.12 - 1.39), area under the ROC curve: 0.64 (95% CI 0.58 - 0.70). Conclusions: The simple risk score provided an accurate prediction of RHD status at 2-years, showing a good performance in a population with milder RHD phenotypes, with a potential value for global risk stratification.
Abstract 11380: Exercise Induced ST Segment Elevation Caused by Coronary Vasospasm
Authors: Kaushik Darbha, Yaoyun S Shen, David Christopher Whang, Sudhakar Prabhu
Journal: Circulation (2022)

Case Presentation: A 52-year-old male with no known medical history was seen in the cardiology clinic for occasional pressure-like chest pain on exertion. Due to an intermediate pretest probability of CAD, ischemic workup with a nuclear perfusion exercise stress test was planned. Patient achieved maximum predicted heart rate after 12 minutes of exercising, with no anginal symptoms, ST segment changes or arrhythmias during the entire period. However, 3 minutes into the recovery phase, he developed chest pain and diaphoresis, with EKG now showing 7mm ST elevations in the inferior leads and BP falling to 77/56 mmHg. STEMI code was called, and patient was emergently taken to the cardiac cath lab for coronary angiogram and possible PCI. Angiogram found the coronary arteries to be non-obstructive but revealed vessels possibly having vasospasm. Intra coronary nitroglycerin was given with no further PCI. The patient’s symptoms subsided after the angiogram, and he remained asymptomatic thereupon and was eventually discharged on Verapamil and nitrate therapy. Discussion: Typically, vasospastic angina occurs at rest. Exercise induced and post-exercise recovery phase ST segment elevation on EKG is associated with severe atherosclerotic disease with significant coronary obstruction. However, exercise induced ST elevations in the post exercise recovery phase caused by non-obstructive, vasospastic coronary arteries, as seen in this patient, is a rare occurrence. The vasospasm is hypothesized to be due to coronary vascular smooth muscle hyperactivity and endothelial cell dysfunction. Treatment is usually with calcium channel blockers, nitrates and lifestyle modification such as smoking cessation and alcohol restriction. This case illustrates the importance of identifying the etiology of the angina, noting that post exercise ST segment elevations are not always associated with coronary vessel obstruction and vasospasm should be considered as a possible etiology.
Abstract 11971: Identification of Response Biomarkers and Signaling Pathways Associated With the LOX-1 Blockade by MEDI6570 in Type 2 Diabetes
Authors: Vijayalakshmi Varma, Dominic Sinibaldi, Emily L Ongstad, Andrea L Vavere, Anders Gabrielsen, Alexandru Schiopu, Richard T George, Li-ming Gan, Jan Nilsson, Anna Collen
Journal: Circulation (2022)

Introduction : Elevated circulating soluble lectin-like oxidized low-density lipoprotein receptor 1 (sLOX-1) levels are associated with risk of MACE and heart failure following acute coronary syndrome (ACS), implying that LOX-1 signaling is a culprit in cardiovascular risk. MEDI6570 is a human monoclonal antibody in clinical trials that binds to LOX-1, antagonizing the interaction with ligands including oxLDL. Methods: To determine LOX-1 risk-related biomarkers and associated pathways in response to MEDI6570, we performed Sparse Partial-Least-Squares Discriminant Analysis on transcriptomics (PBMC) and serum proteomics (OLINK) in strong versus weak responders to MEDI6570 treatment, defined by a decrease in sLOX-1, in patients with type 2 diabetes (T2D) in a single ascending dose, placebo-controlled study (NCT03654313). Biomarkers that showed concordance at three or more timepoints during treatment were further tested in an independent high-risk (T2D and/or CVD) cohort (SUMMIT; n=1231), for correlation with sLOX-1. Results: We identified biomarkers of inflammation that predominated among others, including oxidative stress, apoptosis, cellular adhesion, and migration. Of these, IL-16 and IL-18 showed significant correlation to sLOX-1 (IL-16 r=0.43, p&lt;0.001; IL-18 r=0.44, p&lt;0.001) in the independent SUMMIT cohort. Additionally, in a subset of the SUMMIT cohort, significant correlations were observed between baseline and 20-year follow-up levels for sLOX-1 (r=0.271, p=0.012), IL-16 (r=0.243, p=0.025), and IL-18 (r=0.459, p&lt;0.0001), demonstrating persistent long-term elevation of these inflammatory markers in patients. We also identified neutrophil-related markers (CEACAM8, PRTN3, PGLYRP1, CPB1, GRN, LTBR) in response to MEDI6570, which have not been previously associated with LOX-1. Conclusions: Findings indicate that IL-16 and IL-18 may be potential links between LOX-1 signaling and cardiovascular risk, being modified by treatment with MEDI6570. This study also identified neutrophil-related markers in response to MEDI6570 treatment, implicating a potential role for neutrophils in LOX-1-mediated effects. A phase 2 study in patients with recent ACS and treatment with MEDI6570 or placebo is ongoing (NCT04610892).